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phase 3a > 3a diseases headlines > Flashcards

3a diseases headlines Flashcards

1
Q

Bishop Scoring

A

Rates the favourability of the cervix (10 is good). Based on dilatation, position in vagina, effacement

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2
Q

Partogram

A

Measures progress in labour.

  • dilatation of cervix
  • vital signs
  • liquor colour
  • Fetal heart rate
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3
Q

Cardiotocography

A

Measures FHR and uterine contactions (you expect variability and accelerations), FHR 110-160, no decelerations. Not useful antenatally unless daily in high risk

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4
Q

Fetal scalp samples

A

Amnioscope to get blood sample. pH below 7.2 needs delivery as acidotic and hypoxic

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5
Q

Amniocentesis

A

Fine gauge needle and US. (15 weeks) Chromosomal abnormalities, CMV and toxoplasmosis, Sickle cell, CF and Thallasaemia. 1% miscarry

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6
Q

Chorionic villus sampling

A

Biopsy of trophoblast. (11 weeks (quicker)) Higher miscarriage rates than amniocentesis. PCR and FISH for results.

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7
Q

Sperm sample boundaries of viability

A

5-15 million/mL=oligospermia

<32% motile= asthenospermia

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8
Q

Causes of male subfertility

A 
Idiopathic
Drug exposure (alcohol, smoking, steroids)
Varicocele
Antisperm antibodies
Infections
Kleinfelters
CF
Kallmans
TURP
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9
Q

APGAR score

A 
HR
RR
Muscle tone
Colour
Reflex
/10. At 1 and 5mins. 
Resuscitation? Neuro outcome?
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10
Q

Assisted conception

A 
Intrauterine insemination (IUI) if mild sperm problems. 
Intracytoplasmic sperm injection (ICSI) if severe. 
IVF
-mulitple follicular development
-ovulation and egg collection
-fertilisation and culture
-embryo transfer.
Multiple pregnancy and ovary overstimulation risks
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11
Q

Combined oral contraceptives

A

Exert negative feedback on gonadotrophin release, inhibiting ovulation. Thin endometrium and thicken cervical plug. Withdrawal bleeds if 1 week break, if not then spotting

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12
Q

Progesterone side effects

A 
Depression
Bleeding
Amenorrhoea
Acne
Breast discomfort
Weight gain
Reduced libido
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13
Q

Oestrogen side effects

A 
Nausea
Headaches
Increased mucus
Fluid retention and weight gain
Breast tenderness and fullness
Bleeding
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14
Q

Hormonal contraceptive negatives

A 
Major complications (venous thrombosis, venous thromboembolism, migraine, stroke)
Minor side effects
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15
Q

Depoprovera

A

IM injection every 3 months, reduced bone density. Progesterone

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16
Q

Emergency contraception

A

IUD

Morning after pill

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17
Q

Barrier contraceptives

A 
Male condom
Female condom
Diaphragms
Caps
Spermicides
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18
Q

What is the difference between IUDs and IUSs

A

IUD copper- toxic to sperm

IUS(system)- mirena (progestogen) hormonal.

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19
Q

General advantages and disadvantages

A

User dependence
Complications
Contraceptive
Protects from STIs

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20
Q

Other contraceptives

A

Male and female sterilisation

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21
Q

Pneumonia

A

Fever, tachypnoea, malaise, RDS.
CXR, O2 sats
Amoxicillin
Pneumococcus, mycoplasma, haemophilus, staphylococcus, TB, viral

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22
Q

Croup

A

Viral laryngotracheobronchitis
6 months to 6 years (2yo)
Upper airway obstruction (=stridor, barking cough, hoarse)
Pred

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23
Q

Epiglottitis

A

Caused by H. influenza B so went down cos of vaccine. Very acute, no preceding symptoms. Silent. Cant drink. Drooling. Soft stridor

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24
Q

Asthma

A

Inflammation, hyperresponsiveness, narrowing
Wheeze, cough, breathless, chest tight
Worse at night, triggers, symptoms between exacerbations
Peak flow diary, sleep? exercise?
Salbutamol (ipratropium bromide if young)
Salmeterol
Refer

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25
Q

Viral induced wheeze

A

Increased risk in preterm and maternal smoking, Small airways more likely to narrow and obstruct due to inflammation. Resolves by 5

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26
Q

Bronchiolitis

A 
1-9 months
Poor feeding, apnoea, dry cough, laboured breathing
Respiratory syncytial virus
PCR analysis of nasal secretions
Supportive: humidified oxygen
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27
Q

Cystic fibrosis

A

CTFR chromosome 7
Meconium ileus, pancreatic enzyme deficiency, malabsorption, atypical pneumonia
Hyperinflation, nasal polyp, sinusitis, failure to thrive
Sweat test 60-125
MDT
Physio, Dornase Alpha, pancreatic enzymes, high calorie diet, ICSI

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28
Q

Otitis media

A

6-12 months
Eustachian tubes short, horizontal and dont work
Examine tympanic membrane in all fever infants (bright red, bulging)
RSV, rhinovirus, pneumococcus
Regular anaesthesia
(can lead to with effusion, glue ear)

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29
Q

Grommets

A

Tympanostomy tubes, for ottitis media with effusion. Adenoidectomy can be more effective

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30
Q

Glue ear

A

2-7 years old
Caused by recurrent ear infections
Decreased hearing
Ear drum dull and retracted with fluid level
Flat trace on tympanometry
Conductive hearing loss, speech and language problems.
Grommets and adenoidectomy

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31
Q

Sensorinueral Deafness

A 
Genetic
Injuries, hypoxia, infections
More profound hearing loss
Doesnt improve and may get worse
Amplification or cochlear implant
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32
Q

Conductive hearing loss

A 
Mainly glue ear
Eustachian tube dysfunction (down syndrome, cleft palate)
Wax
Intermittent, not total, resolves
Conservative, amplification or surgery
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33
Q

Periorbital cellulitis

A

Fever, erythema, tenderness of the eyelid
Prompt IV antibiotics
Prevent orbital cellulitis (CT scan, pain, proptosis)

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34
Q

Squint

A

Strabismus, misallignment of visual axis.
Corneal light reflex test and cover test
Glasses, surgery, patches

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35
Q

Septal defects

A

more than 3mm is big
Breathless, recurrent chest infections, endocarditis
CXR, ECG, Echo
Occlusion device, prostaglandin infusion

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36
Q

Heart failure

A

Poor feeding, sweating, tachypnoea, tachycardia, cardiomegaly, gallop, hepatomegaly
neonates=obstructed systemic circulation
infants=high pulmonary flow
older=eisenmenger, rheumatic, cardiomyopathy
Heart lung transplant, diuretics and ACE-I

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37
Q

cyanotic heart disease

A 
Prostaglandin maintains duct patency
CXR, ECG, Doppler echo
Tetralogy of fallot
Transposition of aorta
ASD
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38
Q

Rheumatic fever

A

GABHS
Latent 2-6 weeks then
Pharyngeal infection, polyarthritis, mild fever and malaise
Can lead to pancarditis, involuntary movements and erythema marginatum
Bed rest and aspirin
Antistreptococcal antibodies if persisting

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39
Q

Arrythmias

A

SVT
Carotid sinus massage or ice pack to face
IV adenosine then electrical cardioversion if that fails
Long QT
Sudden LOC during exercise

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40
Q

Subacute bacterial endocarditis

A

Fever, anaemia, pallor, splinter haemorrhages, splenomegaly, necrotic skin lesions
Multiple blood cultures
Strep viridans
High dose penicillin and aminoglycoside IV for 6 weeks

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41
Q

GORD

A

Fluid diet, horizontal posture and short oesophageal length
History of vomiting and failure to thrive
No Ix needed but can do 24hr oesophageal pH test
Thickener to feeds and sit up after feeds

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42
Q

Pyloric stenosis

A

Projectile vomiting in first few weeks of life.
Visible gastric peristalsis, palpable mass on test feed. Ultrasound diagnosis
Surgery, rehydration and electrolyte correction

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43
Q

IBS

A 
Abdo pain, relieved by defecation
Explosive, loose or mucousy stools
Bloating
Feeling of incomplete defecation
Constipation
Family history, psychosocial factors
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44
Q

Gastroenteritis

A

Mostly viral or campylobacter, shigella or salmonella
dehydration
oral rehydration needed in most, IV in shock

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45
Q

Urinary stress incontinence

A

Involuntary leakage of urine on effort or exertion, coughing or sneezing.
Cystometry needed to confirm not overactive bladder.
Vaginal delivery risk factor
Lose weight and duloxetine

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46
Q

Hydratiform mole

A

Gestational trophoblastic disease
Extra proliferation of trophoblast, large uterus, BV bleeding, Snowstorm appearance on US
High serum hCG
Suction cuterrage to remove

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47
Q

Overactive bladder

A

Urgency with or without urge incontinence, usually with frequency or nocturia, in the absence of proven infection.
Urinary diary
Oestrogens, anticholinergics, botox

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48
Q

Uterovaginal prolapse

A

Descent of the uterus and or vaginal walls beyond normal anatomical confines
Graded 1-4 based on descent
Preg, vaginal delivery, obesity, cough, surgery
Pelvic floor exercises, better labour
Lose weight, treat cough. Pessaries. Hysterectomy. Surgery repair

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49
Q

Anterior uterovaginal prolapse

A

Cystourethrococoele

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50
Q

Posterior uterovaginal prolapse

A

Rectocele (rectum) or enterocele (pouch of douglas)

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51
Q

What type of prolapse do you get after hysterectomy

A

Vault prolapse

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52
Q

Genital tract fistula

A

Abnormal connection between urinary tract and other organs. Obstructed labour big cause worldwide. Surgery, radio n malignancy causes. Cystoscopy to prove. Surgery to fix

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53
Q

Ovarian cyst

A

Very painful if ruptures or haemorrhages. Intense pain with endometrioma or dermoid cyst. Urgent surgery

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54
Q

Ovarian torsion

A

Torsion of the pedicle, bulky due to cyst. Causes infarction of the ovary/ tube and severe pain. Urgent surgery and detorsion is required if the ovary is to be saved

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55
Q

Lichen sclerosis

A

Thin vulval epithelium, lost collagen. Severe pruritus, worse at night. Pink white papules. Thin skin. Inflammatory adhesions. Biopsy to exclude cancer. Treatment ultra potent steroids

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56
Q

Cervical cancer

A 
90% squamous, also adenocarcinoma
HPV= cervical intrapithelial neoplasia.
Screening= liquid based cytology
Biopsy
Treatment= biopsy then trachelectomy then hysterectomy then radio/chemo
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57
Q

Endometrial cancer

A

Over 60s
90% adenocarcinoma, some adenosquamous
Pill and pregnancy protective (low oestrogen)
PMB
Hysterectomy and bilateral salpingoophrectomy

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58
Q

Ovarian cancer

A

90% Epithelial, germ cell if under 30
Abdominal distension,
Family history CA125
Late presentation. Hysterectomy. Debulk.

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59
Q

Vulval cancer

A

Vulval intraepithelial neoplasia, HPV and lichen sclerosis
Pruritis, bleeding, discharge mass
Biopsy
Wide local excision

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60
Q

Vaginal cancer

A

Often secondary. Can be primary squamous in older women. Intravaginal radiotherapy treatment.

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61
Q

Marasmus

A

Weight for height more than 3 standard deviations below median (70%), wasted, wizened appearance, apathetic (no oedema)

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62
Q

Kwashiokor

A

Generalised oedema, sparse and depigmented hair, skin rash, angular stomatitis, distended abdomen, enlarged liver, diarrhoea.

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63
Q

Hischprungs

A

No myenteric nerve plexus. Doesnt pass meconium in 48 hours, abdomen distends

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64
Q

Meckel diverticulum

A

Ileal remnant of vitello-intestinal duct. Rectal bleeding not red or melaena. Surgical resection

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65
Q

Wilson disease

A

Autosomal recessive, chromosome 13. Reduced caeruloplasmin and defective bile excretion= increased copper. Liver, brain, kidney, cornea. Liver biopsy, elevated hepatic copper.
Penicillamine, zinc, liver transplant

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66
Q

Henoch schlonein purpura

A 
Skin rash (buttocks, arms and legs), arthralgia, periarticular oedema, abdo pain, glomerulonephritis. IgA and IgG complexes. 
NSAIDs
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67
Q

Alport syndrome

A

Familial nephritis. X linked recessive. Renal failure, males, deafness and ocular defects. Mother has haematuria.

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68
Q

Stephens Johnson syndrome

A

Severe bullous form of erythema multiforme, mucous membranes. Eye and mouth involvement. Drug sensitivity and infections can cause

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69
Q

Kawasakis disease

A

Prolonged fever. Conjunctivitis, cervical lymphadenopathy, polymorphous rash, cracked lips, strawberry tongue, oedema then peeling of hands and feet. Can lead to coronary artery aneurysms. IVIG. Aspirin

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70
Q

Kallman syndrome

A

Delayed or absent puberty and inability to spell. Hypogonadotrophic, hypogonadism. Hormone replacement.

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71
Q

Von willebrands disease

A

Quantitative or qualitiative deficiency of vwf. Defective platelet plugs.
Autosomal dominant
Brusing, excessive bleeding after surgery, mucosal bleeding (menorrhagia).
Mild= desmopressin
Severe= plasma derived F8

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72
Q

Wilms tumour

A

Renal tumour
Nephroblastoma, embryonal renal tissue.
Large abdominal mass (mets to lung). CT.
Chemo then nephrectomy

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73
Q

Kleinfelters syndrome

A 
47, XXY
Infertility
Hypogonadism, small testes
Pubertal development can be normal
Gynaecomastia
Tall stature
Can have education and psych problems
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74
Q

Turners syndrome

A

45, X
Growth hormone therapy and oestrogen.
SHORT FEMALE
Lymphoedema of hands and feet, spoon shaped nails, thick neck. Wide carrying angly, wide nipples, coarctation of aorta, delayed puberty, ovary dysgenesis.

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75
Q

Down syndrome

A

Trisomy 21
Hypotonic, flat occiput, single palmar creases, incurved 5th finger, wide sandal gap.
Learning difficulty, hearing and vision problems
Risk of duodenal atresia and congenital heart disease
Rapid FISH blood tests
Meiotic non disjunction (maternal age), translocation and mosaicism cause

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76
Q

Edwards syndrome

A 
Trisomy 18
Low birthweight
Prominant occiput
Small mouth and chin
Short sternum
Flexed overlapping fingers
Rockerbottom feet
Cardiac and renal malformations
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77
Q

Patau syndrome

A 
Trisomy 13
Structural defect of brain
Scalp defects
Small eyes
Cleft lip and palate
Polydactyly
Cardiac and renal malformations
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78
Q

Angelmans syndrome

A

Imprinting and uniparental disomy (dad).
Chromosome 15
Severe cognitive impairment
Facial appearance (prominent chin, deep set eyes, wide mouth)
Ataxia
Epilepsy

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79
Q

Prader Willi syndrome

A 
Imprinting and uniparental disomy (mum)
Chromosome 15
Hypotonia 
Developmental delay
Hyperphagia
Obesity
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80
Q

Noonan syndrome

A 
Short webbed neck with trident hair line
Pectus excavatum
Short stature
Congenital heart disease
Face (Upturned nose, hooded eyes, low ears)
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81
Q

Williams syndrome

A 
Short
Hypercalcaemia
Congenital heart disease
Learning difficulty
Face (Full lips, gapped teeth, upturned nose, wide mouth)
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82
Q

Perthes disease

A

Avascular necrosis of femoral epiphysis of femoral head then revascularisation and ossification
5-10 year old boy
Hip pain and limp
XRay for increased density then fragmented
Surgical, pin fixation in situ

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83
Q

Kohlers disease

A

Foot bone disease
Navicular bone, avascular necrosis
Osteochondroses

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84
Q

Osgood schlatters

A

Osteochondritis of patellar tendon insertion. Physically active adolescent boys. Hamstring tightness. Reduce activity, physio, splint

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85
Q

Wernicke korsakoff syndrome

A

Thiamine (B1) deficiency. From alcholol abuse
Wernickes= confusion, wide based gait, opthalmoplegia
Korsakoffs= no new memories, confabulation, lack of insight and apathy

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86
Q

Huntingtons disease

A

Chromosome 4, huntingtin gene, CAG repeats. Neostriatum loss. Chorea. slowed reaction times, increased reflexes, slowed dysdiachokinesia

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87
Q

Alzheimers disease

A

5As
Anticholinesterase inhibitors (galantamine, donepexil, rivastigmine; can cause bradycardia n epilepsy).
Higher educational level and CV helath is protective

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88
Q

Horners syndrome

A

Sympathetic fibres disrupted. Miotic, no dilatation, partial ptosis.
MS, Cavernous sinous thrombosis, pancoasts tumour, aortic aneurysm can all cause horners

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89
Q

Bells palsy

A

LMN. Pregnancy and diabetes risk factors
Oedema causes facial nerve entrapment in facial canal. Abrupt onset weakness. Mouth sags, dribbling, watering, impaired facial movements and expression.
Prednisolone

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90
Q

Parkinsons disease

A

Loss of dopaminergic neurones in substantia nigra.
Cogwheel rigidity, bradkinesia, resting tremor
L Dopa
Subthalamic nucleus stimulation

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91
Q

Peyronies disease

A

Scar tissue forms in penis. Causes bend. Collagenase injections can help

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92
Q

Turners syndrome

A 
45X
Short girl
Hands and feet oedema
Coarctation, absent kidney
Webbed neck
Ovarian dysgenesis.
Oestrogen and growth hormone
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93
Q

Ashermans syndrome

A

Adhesions within the uterus
Poor fertility and little menstruation
Hysteroscopy

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94
Q

Pagets disease of the nipple

A

Itchy red scaly or crusted nipple from direct extension of intraductal adenocarcinoma.
Looks like nipple eczema, do a biopsy
Mastectomy or lumpectomy and radio

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95
Q

Whats the difference between Prader Willi and Angelman syndrome

A

Angelman the child has no maternal but two paternal, prader willi the child has no paternal but two maternal

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96
Q

Epigastric pain at night, haematemesis

A

Duodenal ulcer

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97
Q

Diarrhoea, weight loss, blood in stool, growth failure

A

IBD

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98
Q

Vomiting and recurrent abdo pain

A

Pancreatitis

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99
Q

Jaundice and recurrent abdo pain

A

Liver disease

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100
Q

Dysuria, secondary enuresis, abdo pain

A

UTI

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101
Q

Bilious vomiting abdo distension and pain

A

Malrotation

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102
Q

Alcohol dependence

A
  1. compulsion to drink
  2. prioritise drinking over other activities
  3. stereotyped pattern of drinking
  4. increased tolerance to alcohol
  5. repeated withdrawal symptoms
  6. relief drinking to avoid withdrawal
  7. reinstatement after abstinence
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103
Q

Can mental health act be invoked for substance misuse and dependence

A

No but it can be for secondary disorders

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104
Q

First rank symptoms of schizophrenia

A

Auditory hallucinations
Delusions of thought control
Delusions of control (passivity phenomenon)
Delusional perception

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105
Q

Define delusion

A

Unshakeable belief that is held in the face of evidence to the contrary and that cannot be explained by culture or religion

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106
Q

Define hallucination

A

A perception that arises in absence of a stimulus and is not subject to conscious manipulation

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107
Q

Hebephrenic schizophrenia

A

Prominent mood changes

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108
Q

Catatonic schizophrenia

A

Prominent psychomotor disturbances

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109
Q

Residual schizophrenia

A

From an early stage with psychotic symptoms to a secondary phase with negative symptoms

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110
Q

Diagnosing schizophrenia

A

2+ first rank, scoial occupational dysfunction, 6 month period with 1 month of symptoms.
Exclude mood disorder and substance missuse

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111
Q

Schizoaffective disorder

A

Prominent affective and schizophrenic symptoms in the same episode of illness. Different from post schizophrenic depression and bipolar

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112
Q

Bipolar

A 
Bipolar 1= mania and major depression, bipolar 2= hypomania and major depression
Psychological treatments
Antipsychotics, benzos  for manic
Antidepressants for depressive
Mood stabilisers to prevent relapse
Lithium, lamotrigine, valproate
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113
Q

Cyclothymia

A

Numerous episodes of mild elation and mild depressive symptoms that do not meet the criteria for bipolar

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114
Q

Hypomania

A

Mood is elevated expansive or irrtiable. No psychotic features or marked impairment of social functioning

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115
Q

Depression

A

Low mood, low energy and anhedonnia
+poor apetite, sleep, libido, concentration, worthless, hopeless, psychomotor retardation
Psychological, social, SSRIs, SRIIs, TCAs

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116
Q

postpartum depression

A

Edinburgh post natal depression scale. Sertralline, CBT. Have a low threshold for MDT

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117
Q

Post partum pscyhosis

A

2 weeks post partum. Psychotic and affective symptoms. Psychosocial factors. Rapidly fluctuating

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118
Q

Anxiety

A

Exaggerated response to threat or danger. Lasts more than 3 weeks interferes with daily life.
Exervise, meditation, SSRIs or Benzos

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119
Q

OCD

A

Compulsions- senseless repeated rituals. Obsessions- stereotyped, purposeless words, ideas or phrases that come into mind.
CBT, Clomipramine, SSRI

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120
Q

Panic disorders

A

Reoccuring unexpected panic attacks. Fluoxetine

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121
Q

PTSD

A

Reexperiencing, autonomic hyperarousal, avoidance of things attached with event, hyper-vigilance, sleep disturbance, poor concentration
Amygdala
CBT EMDR
SSRIs

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122
Q

Phobia

A

Anxiety is only experienced in certain well defined situations that arent dangerous.
CBT, SSRI, TCA, pregabalin

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123
Q

Somatasisation disorder

A

Physical symptoms that can not be accounted for by a physical disorder or other psychiatric disorder

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124
Q

Personality disorders

A

Longlasting rigid patterns of thought, affect and behaviour

  1. Markedly disharmonious attiudes and behaviours
  2. Prevailing chronic abnormal behaviour patterns
  3. present in broad range of situations
  4. manifest before18 and continue into childhood
  5. personal distress caused by this
  6. occupational and social performance problems
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125
Q

Paranoid personality

A

Suspicious, preoccupied with conspiratorial explanations, distrusts others, holds grudges

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126
Q

Schizoid personality

A

Emotionally cold, lacks interest in others, rich fanatasy world, excessive introseption

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127
Q

Dissocial/ antisocial personality

A

Aggressive, easily frustrated, lack of concern for others, irresponsible, impulsive, unnable to maintain relationships, criminal activity, lack of guilt (psychopath)

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128
Q

Borderline emotionally unstable personality

A

Feeling of emptiness, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self harm, impulsivity, pseudohallucinations

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129
Q

Impulsive emotionally unstable personality

A

Inability to control anger or plan, unpredictable affect and behaviour

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130
Q

Histrionic personality

A

Over dramatize, self centred, shallow affect, labile mood, seeks attention and excitement, manipulative behaviour, seductive

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131
Q

Narcissistic personality

A

high self importance, lacks empathy, takes advantage, gradiose, needs admiration

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132
Q

Anankastic personality

A

OCD, worrier, judgemental

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133
Q

Anxious personality

A

Extremely anxious and tense, self concious and insecure, timid, desires to be liked

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134
Q

Dependent personality

A

Passive, clingy, submissive, excess need for care

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135
Q

Migraine headache

A

Featureful, unilateral, episodic. Sumatriptan, propanolol, aspirin

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136
Q

Tension headache

A

Bilateral pressing headaches. Featureless. Lifestyle advice. Asprinin

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137
Q

Medication overuse headache

A

Worsens on analgesia

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138
Q

Cluster headache

A

Excruciating pain, ipsilateral, autonomic. O2, sumatriptan. Nifedipine, prednisolone

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139
Q

How do you reverse warfarin

A

Beriplex and vitamin K

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140
Q

Stroke

A

Ischaemic, asprin and alteplase within 4.5 hours

Haemorrhagic: beriplex n vit K, IV mannitol

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141
Q

Anterior cerebral artery stroke symptoms

A

Leg signs, trunk apraxia, frontal lobe= drowsy and less spontaneous speech

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142
Q

middle cerebral artery stroke symptoms

A

Facial drop, dysphasia, leg and arm weakness

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143
Q

Posterior cerebral artery stroke symptoms

A

Homonymous hemianopia. Visual signs.

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144
Q

Posterior circualtion stroke symptoms

A

Big. Paresis, LOC, locked in, vertigo

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145
Q

Occipital lobe function

A

Vision

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146
Q

Temporal lobe function

A

Language comprehension, hearing, memory, behaviour

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147
Q

Pitiutary gland function

A

Hormones
Growth
Fertility

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148
Q

Brainstem function

A

Breathing
Blood pressure
Heartbeat
Swallowing

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149
Q

Cerebellum function

A

Balance
Coordination
Fine motor control

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150
Q

Parietal lobe function

A

Judgement, calculations, reading, writing

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151
Q

Cerebellar symptoms

A

Dysdiadochokinesis, Ataxia, Slurred speech, hypotonia, intention tremor, nystagmus, gait

Tumours, infection, stroke, Arnold Chiari malformation, toxic, friedreichs ataxia, MS

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152
Q

Epilepsy

A

Recurrent tendency to spontaneous intermittent, abnormal electricity in part of the brain manifesting in seizures
Focal= carbamazepine (sodium CB)
Generalised= sodium valproate (CCB)

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153
Q

NEAD

A

Resemble seizures but arent associated with electrical activity in the brain. Comorbidities with IBS and fatigue, functional. Immobilisation of body parts is a sign

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154
Q

Narcolepsy

A

(Gelineuas syndrome). Young man, succumbs to inappropriate sleep, hynogogic hallucinations, cataplexy, sleep paralysis. Autoimmune destruction of hypothalamic neuros. Modafinil stimulant is the treatment

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155
Q

Cataplexy

A

Bilateral loss of tone in antigravity muscles provoked by emotions. Associated symptoms. Brief but injury can occur.

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156
Q

Shingles

A

Oral analgesia, Acicolvir.
In one dermatome normally, can be opthalmic.
Herpes Zoster, caused by reactivation of Varicella Zoster

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157
Q

Huntingtons

A

Autosomal dominant neurodegenerative disorder characterised by lack of inhibitory GABA.
Chromosome 4, CAG
Chorea, dysarthria, dysphagia

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158
Q

Vascular dementia

A

Brain damage from vascular pathology. Step wise deterioration
Donepezil (AChI), Memantine (antiglutamate)

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159
Q

Alzheimers disease

A

Accumulation of Beta amyloid plaques and tau protein. 5As. Donepezil, rivastigmine

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160
Q

Normal pressure hydrocephalus

A

Reversible cause of dementia.
Wet whacky wobbly. MRI= hydrocephalus with enlarged ventricles.
VP shunt

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161
Q

Hydrocephalus

A

Abnormal accumulation of CSF in ventricles, often due to blocked aqueduct. In children you get bulging of fontanelles. Brain damage from pressure. Ventirculoperitoneal Shunt

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162
Q

Brain tumours

A

Loss of function, seizures, symptoms of raised ICP, lethargy and tiredness.
Astrocytomas, gliomas, oligodendroglial
Surgery, chemo if glioma, oral dexamethasone

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163
Q

What causes lethargy and tiredness in brain tumours

A

Pressure on brainstem

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164
Q

MS

A

Chronic autoimmune T cell mediated inflammtory disorder causing 2 or more CNS lesions disseminated in time and space (exclude similar). MRI.
IV methpred, betaferon, nataluzimab

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165
Q

GBS

A

Acute ascending inflammatory demyelinating polyneuropathy affecting the peripheral nervous system (Schwann cells) after and URTI or GI infection.
IV IG
Plasma exchange
Enoxaparin

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166
Q

Motor neurone disease

A 
Cluster of major degenerative diseases characterised by selective loss of neurones in the motor cortex, CN nuclei and anterior horn cells. AMLS= upper and lower. Stumbling, foot drop, proximal myopathy, weak grip, aspiration pneumonia. 
Riluzole
Amitryptilline
Baclofen
Diclofenac
MDT
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167
Q

Cerebral palsy

A

Chronic disorders of posture and movement caused by non progressive CNS lesions sustained before 2 years old. Leading to delayed motor development, CNS signs, learning disability and epilepsy.
MDT
Baclofen, physio, respiratory support

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168
Q

Neurofibromatosis

A

Cafe au lait spots, freckling, dermal fibromas, nodular neurofibromas. Lisch nodules.
T1= more common, more cafe, dermal fibromas
T2= also get acoustic schwanoma, hearing loss?

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169
Q

Meningitis

A

Inflammation of the meninges of the brain. Neck stiffness, headache, fever. Non blanching, petechial and purpuric rash.
Ben Pen if in community, cefotaxime in hospital. Over 50 or immunocompromised, add in IV amoxicillin
Ciprofloxacin prophylaxis

170
Q

Encephalitis

A 
Infection and inflammation of the brain parenchyma. 
Altered mental state, headache, fever. 
IV Aciclovir (if viral)
Primidone antiepileptic
IM BenPen if suspect meningitis
171
Q

Bovine papular stomatitis

A

Parapoxvirus associated with papular and erosive lesions on the mouth and lips

172
Q

Bulbar palsy

A

Disease of CN9-12. Tongue, muscles of talking and swallowing, speech.
Caused by MND, GB, polio, MG, brainstem tumours

173
Q

Myastenia Gravis

A

Autoimmune disease against nicotinic ACh receptors in the neuromuscular junction. Anti-AChR IgG. Increasing muscle fatigue (CN, resp, tendon reflexes fatiguable)
Serum AntiAChR
Pyridostigmine (anticholinesterase)

174
Q

Myasthenic crisis

A

Weakeness of respiratory muscles during relapse. Monitor FVC, treat with plasmaphoresis and IV Ig

175
Q

Radiculopathy

A

(Root compression). Pain/ electrical sensations at the level of the compression, with dumbness, dull relexes, weakness and wasting below. Pain management, surgery

176
Q

Sciatica

A

Shooting pain down the leg, pain management and surgery

177
Q

Peripheral neuropathy

A

Can be motor (GBS, lead poisoning, CMT) or sensory (DM, renal, leprosy). Foot care and shoe choices, splinting of joints, amitryptilline

178
Q

Mononeuropathy

A

Focal demyelination at the point of compression can cause disruption of conduction. Splint, steroid injection, decompression surgery

179
Q

Spinal cord compression, cervical spondylosis.

A

Progressive symptoms, UMN leg signs, LMN arm signs, incontinence, hesitancy, urgency. Urgent MRI. Refer, cervical collar, laminectomy

180
Q

Subarrachnoid haemorrhage

A

Spontaneous bleeding into subarachnoid space (between arachnoid layer of meninges. Sudden thunderclap occipital headache, neck stiffness, kernigs sign, brudzinskis sign.
Head CT, star shaped lesion
IV fluids, IV nifedipine.
NEUROSURGEON

181
Q

Extradural haematoma

A

Young adults. Head injury, LOC, lucid interval, followed by LOC. CT Head, Lemon, Biconvex. Skull XR can show a fracture across the middle meningeal artery. ABCDE. IV Mannitol, NEUROSURGEON

182
Q

Subdural haematoma

A

Small brains, alcohol, dementia, child. Bleeding from bridging veins and venous sinuses. Fluctuating consciousness, changes. CT head. Crescent shape. ABCDE. IV mannitol

183
Q

Anterior cord syndrome

A

Ischaemia of the anterior cord artery. Corticospinal tract so complete motor paralysis below. Loss of pain and temperature as spinothlamic. Still have proprioception and vibration as dorsal columns. Bad prognosis

184
Q

Status epilepticus

A

Seizures lasting more than 30 minutes without intervening consciousness.
IV Diazepam
IVI Phenytoin
Seek ICU help

185
Q

Raised ICP

A 
Headache worse on coughing, leaning forwards
Alterered GCS
History of trauma
Pupil changes
Papilloedema and reduced visual acuity
Craniotomy or Burr hole
IV Mannitol
Sedation
Identify cause.
Herniation and coning. 
Uncal herniation (3rd nerve)
Cerebellar tonsil herniation (6th nerve palsy)
Subfalcian herniation (frontal lobe)
186
Q

Coma

A 
Unrousable unresponsiveness
ABC
IV access
Stabilise cervical spine
Blood glucose
Control seizures
ABG, FBC, U&amp;E, LFT, ethanol, toxin screen, drug levels. Blood and urine culture. CXR, CT head
187
Q

Brain abscess

A

Inflammation and collection of infected materials coming from local or remote infections. Headache, neck stiffness, fever, N and V,
Ear, dental or sinus abscess
Pneumonia or trauma
Aspiration surgery, craniotomy, antibiotics

188
Q

Myopathy

A

Primary disorder of muscle with gradual onset symmetrical weakness. Proximal, preserved reflexes, no sensory problems, no fasciculation
Steroids, inflammatory, metabolic, myotonic, statin, muscular dystrophy, polio

189
Q

UMN signs

A 
Babinskis sign
Spasticity (increased muscle tone)
Refelexes brisk
Flexed upper, extended lower
Emotional liability
190
Q

LMN signs

A

Reduced muscle tone
Muscle wasting
Fasciculations
Reduced reflexes

191
Q

GCS categories

A

Eye verbal motor

192
Q

GCS Eye order

A

None, pain, speech, spontaneous

193
Q

GCS verbal order

A

None, incomprehensible, innapopriate, confused, orientated

194
Q

GCS motor order

A

None, extension, flexion, withdraws, localises, obeys command

195
Q 
Dermatomes
Nipple
Belly button
Knee
Big toe
Perianal
Anus
A 
T4
T10
L4
L5
S4
S5
196
Q

Myotome for
pelvis
penis

A

C345 keeps diaphragm alive

S234 keeps the penis off the floor

197
Q

Childhood epilepsy

A 
Focal- carbamazepine
Generalised- sodium valproate
EEG
Monotherapy to reduce SE
Liaise with school
198
Q

ADHD

A

Cannot sustain attention, excessively active, socially disinhibited, may be poor at relationships, prone to temper tantrums, poor school performance.
Educational psychologist, behaviour programme at school, parenting interventions
Methylphenidate

199
Q

Autism spectrum disorders

A

Presents at 2-4yo with social interaction, speech and language disorder and imposition of routines with ritualistic and repetitive behaviour.
Behaviour modification- applied behaivoural analysis
Also often learning difficulties and ADHD, epilepsy

200
Q

Anorexia nervosa

A

Distorted body image, determined efforts to lose weight, arrest of puberty, cessation of periods.
Family therapy and therapy to restore body weight
Increased risk of suicide, malnutrition and infection

201
Q

Bulimia

A

Overating followed by self induced vomiting. As in anorexia, there is a morbid preoccupation with weight and body shape

202
Q

Undescended testes

A

More common in preterm
Retractile? Palpable? Impalpable?
Laparoscopy is best (US and hormonal tests too)
Orchidopexy

203
Q

Testicular torsion

A

Lower abdo or inguinal pain
6-12 hours to act
Undescended= higher risk
Surgery is needed and fixation of the contralateral testes to ensure that that one does tort

204
Q

Premature sexual development

A

Secondary sexual characteristics before 8 in girls or 9 in boys.
US of ovaries and uterus in girls
MRI of hypothalamic region in boys
Girls can have excess GnRH analgoue (Zolardex).
Early growth spurts and fusion of growth plates results in reduced final height.

205
Q

Thelarche

A

Breast development

206
Q

Pubarche

A

Pubic hair development

207
Q

Hypothyroidism

A

Congenital hypothyroidism can be identified on guthrie test (raised TSH)
Caused by maldescent of the thyroid and athyrosis; or iodine deficiency, dyshormonogenesis too.
Lifelong thyroxine treatment: ensures adequate intelectual development

208
Q

Gonadotrophin insufficiency

A

Can be caused by Prader Willi and congenital hypopituitarism.
Results in a small penis and cryptorchidism

209
Q

Hypothalamic tumours

A

Excess LH and FSH can lead to premature puberty, can also cause adrenal insufficiency. May present with a headache

210
Q

Congenital adrenal hyperplasia

A

Autosomal recessive of adrenal steroid biosynthesis (deficiency of 21 hydroxylase)

Girls= virilisation and male characteristics
Boys= salt loss, tall stature and precocious puberty

Long term glucocorticoids, mineralocorticoids and salt if needed. Surgery for girls. Monitor bones and plasma androgens

211
Q

Androgen insensitivity syndrome

A

Under virilisation in a boy
Can cause inguinal hernia in a girl
Inadequate androgen action as unable to respond to androgens.

212
Q

Obesity

A

Obese = BMI> 98th centile for age and sex
Overweight=BMI>91st centile for age and sex
Hypothyroidism, Cushing and Prader Willi rare
Lifestyle and cultural changes needed

213
Q

Child abuse

A

Physical, emotional, sexual abuse, neglect, fabricated or induced illness.
Interests of the child should be kept uppermost to ensure protection from harm
Good communication with parents and child is vital

214
Q

Microcytic anaemia

A

Low MCV and low MCH. Low serum ferritin.
Low Iron
Beta thalassaemia, alpha thalassaemia, anaemia of chronic disease
Dietary advice and oral iron

215
Q

Beta Thalassaemia major

A

Beta globin gene, therefore cant make HbA.
Severe anaemia, failure to thrive/ growth failure, hepatosplenomegaly
Regular blood transfusions and iron chelation (desferrioxamine)

216
Q

Beta Thalassaemia trait or alpha thalassaemia trait

A

Mild iron deficiency and can cause diagnostic confusion

217
Q

Alpha thalassaemia

A

Deletion of all 4 alpha globin genes. Barts hyrdrops, death in utero or within hours of birth

218
Q

Haemolytic disease of the newborn

A

Anaemia, hydrops, hepatosplenomegaly and jaundice. Rare now as antenatal screening, but can still happen as there are other RBC antibodies such as Kell. Anti D immunoglobulin is given to rhesus negative mothers.

219
Q

Sickle cell anaemia

A

Autosomal recessive
Sickled red cells lead to ischaemia in organs and bones.
Anaemia, infection, painful crises, sequestration crises, splenomegaly, growth failure, gallstones, behaviour and learning problems.
Acute chest syndrome and strokes also
Management
-prophylactic penicillin and immunisation
-focial acid and maintain good hydration
-analgesia and blood transfusion for crises.
Hydroxyurea as treatment or bone marrow transplant

220
Q

Fanconi anaemia

A

Aplastic anaemia
Autosomal recessive
Abnormal radii and thumbs, short, micropthalmia, pigmented skin
Dx: Increased chromosomal breakage of peripheral blood lymphocytes
Risk of bone marrow failure or ALL so treatment is Bone Marrow Transplant

221
Q

Haemophilia

A

X linked recessive disorders (A=8, B=9)
Recurrent spontaneous bleeding into joints and muscles at about 1 year of age.
Treatment is recombinant factor 8 or 9 and desmopressin.
Challenging treatment as IV access and inhibitors

222
Q

Immune thrombocytopenia

A

2-10 years
Widespread petechiae and purpura and superficial bruising
FBC and blood film
Self limiting so no treatment normally

223
Q

Leukaemia

A

FBC, Bone marrow examination ?Blast cells, morphology phenotyping
Normally ALL. rarely acute myeloid.
Vincristine and dexamethasone

224
Q

Brain tumour in children

A

Astrocytoma, medulloblastoma, ependymoma, craniopharyngoioma
MRI scan no LP
Surgery for hydrocephalus, get a tissue biopsy

225
Q

Neuroblastoma

A 
Under 5
Neural crest tissue in adrenal medulla
Raised urinary catecholamine level
MIBG scan
Surgery and chemo for mets
226
Q

Retinoblastoma

A 
Malignant tumour of retinal cells.
Chromosome 13= bilateral
White pupillary reflex
MRI and examination under anaesthetic
Chemo then lazer therapy
227
Q

Bone tumour

A

Osteogenic sarcoma or ewing sarcoma (younger). Persistent localised bone pain. Then mass.
Plain XR, MRI, bone scan
Ewing= big soft tissue mass
Combination chemo then surgery, en bloc resection

228
Q

Hepatoblastoma

A

Abdominal distension and mass

Elevated serum alpha fetoprotein

229
Q

Fragile X

A 
Moderate- severe learning difficulty
Macrocephaly
Macro orchidism
Long face, large everted ears, mitral valve prolapse, scoliosis, autism, hyperactive
CGG repeats
230
Q

Cystic fibrosis

A

Sweat test 60-125 then gene testing
Defective CTFR on chromosome 7
Thick meconium, Mucopurulent lung secretions and imapaired ciliary function, pancreatic enzyme deficiency
MDT Dornase alpha, Pancreatic enzyme replacement, MDT

231
Q

Duchenne, Becker, Dystrophy

A

X linked, waddling gait and language delay. Gowers sign (turn prose to rise), fat calves.
Exercise, lengthening achilles, CPAP for sleep
Duchenne at 5, becker less serious at 11

232
Q

Osteogenesis imperfecta

A

Autosomal dominant
Blue sclera, fractures, hearing loss
Bisphosphonates prevent fractures
Type 1 common, Type 3 fatal

233
Q

Rickets

A

Nutritional- breast feed to late infancy
Serum calcium and phsophate low. Plasma alkphos high, PTH high, 25-VitD low
Xray= cupping and fraying of metaphysis and widened epiphyseal plate

234
Q

Transient synovitis

A

Common cause of hip pain or limp.
Different to septic arthritis as no fever, child looks well, resolves within a week. Comfortable at rest, can get analgesia

235
Q

Septic arthritis

A

Acute onset, high fever, child looks ill, severe pain, raised ESR, fluid in joint, widened joint space.
Joint aspiration treatment
Prolonged antibiotics, rest and analgesia.
Severe joint damage if not treated

236
Q

Osteomyelitis

A

Fever, painful, immobile limb, swelling, extreme tenderness, especially on moving limb
Positive blood cultures
Parenteral blood cultures
Surgical drainage if unresponsive

237
Q

Placenta praevia

A

Placenta implanted in uterine lower segment
Marginal= near Major= over
RF: large placenta, scarred uterus, high parity/age
Ultrasound
Painless APH
Scan at 32 then 37. Admit whenever bleeding and give steroids. If not then do a C section

238
Q

Placenta accreta

A

Abnormal adherence of all or part of the placenta to the uterus. Predisposes to PPH and they should have a csection

239
Q

Placenta increta

A

Abnormal adherence and infiltration of the placenta into the myometrium. Predisposes to PPH and they should have a csection

240
Q

Placental abruption

A

Seperation of part or all of the placenta before delivery, after 24 weeks.
IUGR, preeclampsia, AI, smoking, previous all risk factors.
Can cause fetal death, DIC, renal failure and maternal death.
Painful APH. Tender woody uterus.
CTG
Induce labour, c section if baby in distress. Wait if preterm and minor

241
Q

Uterine rupture

A

Can be de novo or from an old scar. The fetus is extruded and the uterus contracts down and bleeds from the rupture site, causing fetal hypoxia and massive internal maternal haemorrhage. Lower is not as bad as less vascular.
Scarred uterus, congenital abnormalities and big babies.
Maternal resus with fluid and blood.
Laparotomy to deliver baby.

242
Q

Cervical show

A

Effacement is when the normally tubular cervix is drawn up into the lower segment until it is flat. This is often accompanied by a ‘show’ or pink/white mucus plug from the cervix and/or rupture of the membranes, causing release of liquor.

243
Q

Vasa praevia

A

Occurs when a fetal blood vessel runs in the membranes in front of the presenting part. (Velamentous insertion) Painless moderate vaginal bleeding at amniotomy or spontaneous rupture of the membranes and severe fetal distress

244
Q

Baby blues

A

Third day blues- temporary emotional lability requiring support and reassurance.
Edinburgh postnatal depression scale for post natal depression.

245
Q

Puerperal pscyhosis

A

Abrupt onset of pscyhotic symptoms. 4th day. Needs psych admission and major tranquillizers after exclusion of organic illness

246
Q

Puerperal infection

A

Uterine, wound and urine infection.
Can also get chest or perineal, or mastitis.
Pyrexia, pain, prolonged SROM.
Endometritis= abx and sensitivity and ERPC
Others= clean, abx, physio

247
Q

Rectocele

A

Herniation of the anterior wall of the rectum into the vagina. Rectal symptoms

248
Q

Cystocele

A

Herniation of the bladder into the vagina. Urinary symptoms

249
Q

Endometriosis

A

Endometrium outside the uterus. Peritoneal inflammation causes fibrosis, adhesions and chocolate cysts.
Cyclical pelvic pain, dysmenorrhoea, dyspareunia, subfertlity, pain passing stool.
Laparoscopic biopsy
Mirena coil then COCP
Laparoscopic ablation

250
Q

Adenomyosis

A

Endometrium grows into the myometrium to form adenomyosis.
Regular heavy menstruation (menorrhagia)
MRI
Mirena coil

251
Q

Androgen insensitivity syndrome

A

When male has cell receptor insensitivity to androgens; these are then converted peripherally to oestrogens. Actually a boy, presents amenorrhoeic with testes which need removing cos of malignancy risk

252
Q

Atrophic vaginitis

A

Due to oestrogen deficiency (before menarche, during lactation or after menopause). Oestrogen cream or HRT

253
Q

Kohlers disease

A

Navicular bone loses its blood supply causing bone disorder of the foot in a boy between 6 and 9

254
Q

Discoid meniscus

A

Anatomical variation of the lateral meniscus of the knee, presents with pain, swelling and a snapping sound

255
Q

Slipped femoral epiphysis

A

Adolescent with limp or hip pain.
Obese boy, displacement of femoral head posterio-inferiorly requiring prompt treatment to prevent avascular necrosis.
XRay in from frog lateral view
Surgical management with pin fixation in situ

256
Q

Developmental dysplasia of the hip

A

Identified on screening at birth or 8 weeks, detection of assymetry of skinfolds around hip, limited abduction of the hip, shortening of the affected leg or a limp

257
Q

Juvenile idiopathic arthritis

A

Persistent joint swelling presenting before 16yo in the absense of infection or any other defined cause. Number of joints affected? Systemic? Rheumatoid factor? HLA B27? Morning stiffness and pain.
-Anterioir uveitis, flexion contractures, growth failure,
MDT, NSAIDs, Joint injections, methotrexate
Try and avoid systemic corticosteroids and biologics

258
Q

Impetigo

A

Staph or strep erythematous macules which may become vesicular, pustular or bullous. Coamoxiclav or flucox.
Highly contagious. Nasal carriage.
Face or neck mainly

259
Q

Slapped cheek syndrome

A

Parvovirus B19
Erythema infectiosum- slapped cheek then lace like rash on trunk and limbs.
Can cause aplastic crisis in haemolytic anaemia children.

260
Q

Candida

A

Can complicate nappy rashes. Erythematous in skin flexures and can be sattelite lesions.
Topical antifungal agent

261
Q

Toxic shock syndrome

A

High fever, hypotension, diffuse erythematous macular rash.
Toxin produced by Staph or Group A strep.
Can cause serious complications- desquamification of palms, soles, fingers and toes.
PVL toxin- Panton Valentine Leukocidin

IVIG

262
Q

Toddlers diarrhoea

A

Chronic non specific diarrhoea
Undigested vegetables common
Child well, will be fine. Intestinal motility immature
Better to have fat than fruit juice

263
Q

Colic

A

Paroxysmal inconsulable crying, drawing up of kneees and excessive flatus
Supportive treatment, will resolve. is benign
Gripe water may help.
First 4 months of life
(If severe could be GORD or cows milk allergy)

264
Q

Biliary atresia

A

Destruction or absence of the extrahepatic biliary tree and intra hepatic biliary ducts.
Jaundice, hepatosplenomegaly, white stools
Surgery or chronic liver failure and death
Laparotomy and cholangiography= no biliary tree
Liver transplant

265
Q

Choledochal cysts

A

Cystic dilatations of the extrahepatic biliary cystem
Abdo pain, mass, jaundice, cholangitis
Ultrasound
Surgical excision

266
Q

Neonatal hepatitis syndrome

A

IUGR and hepatosplenomegaly at birth is distinctive

Liver biopsy= giant cell hepatitis

267
Q

Liver failure (fulminant hepatitis)

A

Large hepatic necrosis with subsequent loss of liver function.
Paracetamol overdose, viral hepatitis, metabolic conditions.
Jaundice, encephalopahty, coagulopathy, hypoglycaemia and electrolyte disturbance
Highly derranged bloods (Alk phos, ALT, AST, ammonia\0
Treat all the complications and then transplant

268
Q

Pyelonephritis

A

Inflammation of the kidney as a result of a bacterial infection.
Ecoli, klebsiella, proteus
Can damage the growing kidney by forming a renal scar which may result in HTN and CKD

269
Q

Nocturnal enuresis

A

More males.
Over 6 is abnormal.
Explanation, star charts, enuresis alarm
Sometimes desmopressin

270
Q

Acute kidney injury

A

Sudden potentially reversible reduction in renal function.
Prerenal: hypovolaemic, circulatory failure
Renal: Vacular, tubular, glomerular, pyelonephritis
Postrenal: obstruction
Treat underlying cause, metabolic abnormalities, dialysis if needed

271
Q

Chronic renal failure

A

<15ml/ min/ 1.73m
Congenital (structural malformation/neuropahty)
US, anorexia and lethargy, failure to grow, renal rickets, HTN, proteinuria, anaemia.
Mx: Diet, Vit D, water, EPO, GH
Dailysis and transplant

272
Q

Nephrotic syndrome

A

OEDEMA (anywhere)
Heavy proteinuria
Low plasma albumin
Oral pred

273
Q

Hypospadies

A 
Urethral opening proximal to normal meatus
1) ventral urethral meatus
2) hooded dorsal foreskin
3) chordee (curved erection)
Surgery
274
Q

Resuscitation

A

5 initial rescue breaths then

15 chest compressions to 2 breaths at a rate of 100-120 compressions/ min

275
Q

Respiratory distress syndrome

A

Very preterm infants
Surfactant deficiency
Antenatal corticosteroids and surfactant therapy helps

276
Q

Bronchopulmonary dysplasia

A

Oxygen requirement at a post menstrual age of 36 weeks.
Damage from artificial intubation or infection.
Additional oxygen therapy

277
Q

Meconium aspiration

A

Baby past due date

Large bore suction cannula if causing problems

278
Q

hypoxic ischaemic encephalopathy

A

Birth asphyxia

Can cause cerebral palsy

279
Q

TORCH infection

A

Toxoplasmosis gondii (protozoan)
Retinopathy
Cerebral calcification
Hydrocephalus

Undercooked food and cat litter

280
Q

Neonatal jaundice and kernicterus

A

Can be caused by rhesus haemolytic disease
Give exchange transfusion, phototherapy
Phototherapy and excess water

Kernicterus caused by bilirubin deposition in basal ganglia

281
Q

Necrotising enterocolitits

A

XRAY= Intramural air, Air under diaphragm and in portal tract
Distended bowel loops
Bacterial infection of ischaemic bowel,
Stop feeding, give broad spectrum abx n feed

282
Q

Gastrochicis

A

Bowel protrudes through defect in anterior abdomen wall
Protein loss and dehydration (wrap it)
Surgery

283
Q

Bowel atresia

A

Obstruction and distension
Absense at the normal site
Surgical treatment

284
Q

Gestational diabetes

A

Tight control preconception.
Macrosomic, hyperglycaemia, hyperinsulinaemia, increased risk of congential abnormalities
Increased risk of asphixiation and birth trauma
When born can get hypo n Polycythaemia

285
Q

Maternal hyperthyroidism

A

Tachycardia on CTG
Goitre on US
Irritability, weight loss, tachycardia, heart failure, diarrhoea, exopthalmos
Carbimazole

286
Q

Hypoglycaemia

A

Small, poor glycogen stores, maternal diabetes, low birth weight, large for date but also IUGR
= jittery, irritable, apnoea, lethargy, drowsy, seizures
Early n frequent milk feeds
IV dextrose
Glucagon or hydrocortisone

287
Q

Group B strep

A

Preterm, prom, chorioamniotitis
Early sepsis (=RDS and pneumonia)
Late over 3 month (=meningitis or local)
Give penicillin

288
Q

Listeria

A

Listeria monocytogenes
Leads to respiratory distress, apnoea, temperature instability
Amoxicillin and gentamycin

289
Q

HSV encephalitis

A

Passage through infected birth canal
localised herpetic lesions or encephalitis
Aciclovir
C section if known disease

290
Q

Cleft lip

A

Failure of fusion of the frontonasal and maxillary processes
Chromosomal disorder, mother epilepsy
Orthodontics help with feeds, dental prostheses
Surgery

291
Q

Cleft palate

A

Failure of fusion of the palantine process and nasal septum
Secondary secretory otitis media common
Surgery

292
Q

When do you get vaccinated before youre 1

A

8, 12, 16 weeks

293
Q

Which vaccinations do you get at 8 weeks

A

6 in 1
Rotavirus
Pneuomcoccal vaccine
Men B

294
Q

Which vaccinations do you get at 12 weeks

A

6 in 1

Rotavirus

295
Q

Which vaccinations do you get at 16 weeks

A

6 in 1
Pneumococcal vaccine
Men B

296
Q

When do you get vaccinated between 1 and 15

A 
1 year
2-10 years
3 years and 4 months
12-13 years
14 years
297
Q

What vaccinations do you get at 1 year

A

Pneumococcal vaccine
Men B
Hib/MenC
MMR

298
Q

What vaccinations do you get at 2-10 years

A

Flu vaccine

299
Q

What vaccines do you get at 3 years and 4 months

A

MMR

4 in 1 preschool booster

300
Q

What vaccine do you get at 13-14 years

A

HPV vaccine

301
Q

What vaccine do you get at 14 years

A

3 in 1 teenage booster

Men ACWY

302
Q

When do you get vaccines as an adult

A

65 years
70 years
Every year after 65

303
Q

What vaccine do pregnant women get from 16 weeks

A

Pertussis

304
Q

What vaccine do you get at 65 years

A

Pneuomococcal vaccine

305
Q

What vaccine do you get at 70 years

A

Shingles vaccine

306
Q

Whats in the 6 in 1 vaccine

A 
Diptheria
Tetanus
Polio
Whooping cough
Hep B
Hib
307
Q

Whats in the 4 in 1 vaccine

A

Diptheria
Tetanus
Polio
Whooping cough

308
Q

Whats in the 3 in 1 vaccine

A

Diptheria
Tetanus
Polio

309
Q

When should a child be crawling

A

8-9months

310
Q

Thrush

A 
Candida albicans
Resembles cottage cheese
Broad abx, immunosupressed
Inflamed, superficial dysparenia
Oral fluconazole
311
Q

Chlamydia

A

Chlamydia trachomatis
Dysuria, white pus
NAAT (F=Vulvovaginal swab, M= first pass urine)
Azithromycin 1g stat

312
Q

Bacterial vaginosis

A

Grey/ yellow, thin, fishy discharge. Microscopy, metronidazole

313
Q

Trichomonas

A 
Trichomonas vaginalis
Green frothy discharge
Strawberry cervix
Wet microscopy
Metronidazole
314
Q

Gonorrhoea

A

Neisseria gonorrhoea
NAAT
Azithromycin + IM cefrtiaxone

315
Q

Herpes

A

1=oral, 2=genital
Multiple painful ulcers
Swab for viral culture
PO acyclovir

316
Q

Syphilis

A

Treponema pallidum
Single painless papule- chancre
Blood serology for virus
IM BenPen

317
Q

Genital warts

A

HPV
STI screen
Cryotherapy/ podophyllotoxin cream

318
Q

HIV

A 
Good management before conception
PCP prophylaxis
Maternal and neonatal antiretroviral
C section
Avoid breastfeeding
319
Q

Contact tracing

A

Identification and contacting recent sexual partners, carried out by the patient normally

320
Q

Fibroadenoma

A

Under 30
Firm, smooth, mobile, painless
Breast mouse
Benign overgrowth, USS/Fine needle aspiration or excission if large

321
Q

Breast cyst

A

Perimenopausal
Benign, fluid filled, not fixed
Can be painful
Fine needle aspiration diagnosis

322
Q

Breast abscess

A

Fluid filled, infective
Needle drainage, ultrasound
Flucoxacillin

323
Q

Pagets disease of the nipple

A

Extension of intraductal adenocarcinoma. Itchy, red scaly crusty. Similar to nipple eczema. Do a biopsy then treat with surgery

324
Q

Ductal carcinoma in situ

A

Presence of abnormal cells within the milk ducts of the breast

325
Q

Three stage breast lump investigation

A

Clinical examination
Imaging (US if <35, then mammo and US)
Histology (Fine needle aspiration)

326
Q

ABCDE of breast cancer

A 
Assymetry
Border
Colour
Diameter
Evolution
327
Q

Breast cancer types

A

Non invasive ductal carcinoma
Invasive ductal carcinoma
Invasive lobular
Medullary

328
Q

Breast implant

A 
MRI for imaging
Capsule formation
Infection
Rupture
Shape changes
329
Q

Human sexuality

A

Persons capacity for sexual feelings and orientation

Determined in adolescense

330
Q

Oligohydramnios

A

Hypoperfusion of the placenta

Can be caused by preeclampsia

331
Q

Polyhydramnios

A

Excessive amniotic fluid

can be caused by diabetes, fetal abormality or idiopathic

332
Q

Instrumental delivery

A

Prolonged active second stage, maternal exhaustion, fetal distress
Prerequisites: fully dilated, head deeply engaged, analgesia, indication, empty bladder
Laceration, PPH, 3rd degree tears
Laceration, facial injury, hypoxia

333
Q

Multiple pregnancy

A 
IVF, genetic, older
3+ fetal poles, vomiting, ultrasound
Serial ultrasounds, folic acid, anomaly scan
Increased surveillance
C section if first twin not cephalic
334
Q

Transverse/ oblique lie

A

Lie of fetus not parallel to long axis of uterus
Admit at 37
C section if not corrected by 41

335
Q

Breech

A

Presenting part is feet or buttocks

External cephalic version at 37

336
Q

Cord prolapse

A

After membranes have ruptured the cord prolapses below the presenting part.
Patient on all fours
C section normally

337
Q

Obstructed labour

A

Fetus does not exit the uterus during labour despite normal uterine activity, due to a physical blockage
More common in developing world

338
Q

Hypoactive uterus

A

Atony
Following long labour twins, nulliparous
Misoprostolol

339
Q

Cephalopelvic disproportion

A

Inability to deliver uterus despite
-adequate uterine contraction
-absence of malpresentation or malrotation
C section

340
Q

Gonorrhoea in pregnancy

A

IM Ceftriaxone and arithyromycin

Treatment reduces incidence of preterm birth

341
Q

Group B strep in pregnancy

A

Intrapartum penicillin if at risk, 3rd trimester screening

342
Q

Anaemia in pregnancy

A 
Folic acid (especially if epileptic or previous neural tube defect)
IV if bad and poorly tolerated
343
Q

UTI in pregnancy

A

Preterm labour, anaemia, perinatal mortality
Often E Coli
Bacteria should be cultured at booking visit

344
Q

Secondary post partum haemorrhage

A

Due endometriosis or RPOC. Give antibiotics, do evacuation of products.

345
Q

Primary post partum haemorrhage

A 
Blood lost within 24 hours of delivery
-minor 500-1000 -major 1000+
Uterine atony, retained placental parts, lacerations
Ergometrine
Bimanual uterine compression
Haemostatic suture
346
Q

VTE in pregnancy

A 
Pregnancy is prothrombotic
Immobility, clotting factors increased, fibrinolytic activity is reduced
Doppler for DVT
CXR, ABG and CT for PE
Subcut LMWH
347
Q

Rhesus immunisation

A 
Maternal antibody response against fetal RBC antigen. 
AntiD prophylaxis at 28 weeks
(antiC and antiKell exist too)
Severe anaemia, jaundice, hydrops
Blood transfusion needed
348
Q

Parkinsons

A

Pill rolling tremor
Cog wheel rigidity
Bradykinesia
Levodopa, ropinirole

349
Q

Falls

A

Event where person inadvertantly comes to rest at a lower level.
Can cause pressure ulcers, rhabdomyolitis, dehydration, fractures

350
Q

Incontinence

A

Stress, urge, functional
Pelvic floor exercises
Incontinence diary

351
Q

Delirium

A

Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception.
Infection, drugs, intracranial and environmental causes
Hypoactive or hyperactive

352
Q

Dementia

A

progressive chronic deterioration in cognition, perception or memory.
Alzheimers, lewy body, vascular
Anticholinesteras- rivastigmine

353
Q

Osteoporosis

A

Reduced bone density due to imbalance between bone remodelling and resorption
Smoking, steroids, FHx, underweight, early menopause
Bishosphonates like alendronic acid
FRAX

354
Q

Suicide

A

Intentional self inflicted death
Underlying mental health issues
Focus on why, and understand whole situation
Look at the means and protective factors

355
Q

Old age psychiatry

A

Specialised hollistic care for older people with mental health issues including dementia, depression and schizophrenia

356
Q

Mental health law

A

To detain someone it must be

  • mental health disorder
  • nature or degree to warrant detention in hospital
  • risk to self, others of health
357
Q

Antipsychotics

A

1st gen= sulpiride, haloperidol, flupentixol, chlorpromazine (more EPS)
2nd gen= olanzapine, risperidone, quetiapine, aripiprazole (MSE)

358
Q

Antidepressants

A 
SSRI
Tricyclic TCA
Serotonin noradrenaline reuptake inhibitors (venlafaxine, duloxetine)
Tetracyclic 
Monamine oxidase inhibitors
359
Q

Mood stabilisers

A

Lithium
Olanzapine (antipscyhotic)
Anticonsulvants

360
Q

Tranquilisers/ anxiolytics

A

First and second line talking treatment
Sertraline SSRI
Benzodiazepine
Pregabalin

361
Q

Lithium toxicity

A

Renal impairment, tremor, confusion, thyroid dysfunction, weight gain

362
Q

Clozapine toxicity

A

Weight gain, agranulocytosis

363
Q

Paraphilias

A

Condition characterised by abnormal sexual desires

364
Q

Sexual dysfunction

A

a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity.

365
Q

Sexual aversion disorder

A

Persistent or recurrent extreme aversion to and avoidance of all or almost all genital sexual contact with a sexual partner.

366
Q

Hypoactive sexual desire disorder

A

Persistent deficient sexual/erotic thoughts or fantasies and desire for sexual activity

367
Q

Female sexual arousal disorder

A

Persistent deficient sexual/erotic thoughts or fantasies and desire for sexual activityse

368
Q

Erectile disorder

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
Chronic, medical, hormonal disorders. Ineffective stimuli. Pain.
Sildenafil, alprostadil (injection or pellet intraurethral)

369
Q

Orgasmic disorder

A

Orgasm either does not occur or is markedly delayed
Ageing, chronic medical and hormonal problems.
Psychotherapy and physical meds

370
Q

Delayed/ inhibited/ rapid ejaculation

A

Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
Local anaesthetic and behavioural interventions (stop, start, squeeze)

371
Q

Retrograde ejaculation

A

Semen enters bladder instead of emptying into penis during ejaculation.
Look for presence of spermatozoa and fructose in urine

372
Q

Dyspareunia

A

Pain during intercourse in either women or men. Often attributed to local pathology and should then be properly categorised under the pathological condition.

373
Q

Vaginismus

A

Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful (ICD)

374
Q

Vulvodynia

A

Vulvodynia is persistent, unexplained pain in the vulva

375
Q

Azoospermia

A

Absence of sperm in the ejaculate.

376
Q

Neuroleptic malignant syndrome

A

Long term use can produce movements of the face (tardive dyskinesia)

377
Q

Serotonin syndrome

A

Cognitive changes
Autonomic changes
Neuromuscular changes

378
Q

Electroconvulsive therapy

A

Can be used in treatment resistent depression

379
Q

Counselling

A

Counselling, CBT and psychoeducation can be done in primary care.
DBT, psychoanalytic, group and family therapy are specialist

380
Q

Hypospadies

A

Ventral urethral meatus
Downward curve of the penis
Dorsal hood

381
Q

Anejaculation

A

Pathological inability to ejaculate in males, with or without orgasm

382
Q

Dysfunctional endometrial bleeding

A

irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy

383
Q

Menopause

A

Permanent cessation of menstruation resulting from loss of ovarian follicular activity
Premature if before 40
Hot flushes, insomnia, skin, vagina and breast atrophy, hair loss, prolapse, osteoporosis, CV disease
Low antimullerian hormone, high FSH
Consider HRT and bisphosphonates

384
Q

Menarche

A

Onset of menstruation
Normally last manifestation of puberty, 13yo average
Before 16 (or 14 if no other characteristics)
23-35 days
8 days bleeding, less than 80ml total

385
Q

Essential hypertension

A

When the blood pressure exceeds 140/90 before 20 weeks

386
Q

Preeclampsia

A

Multisystem disease unique to pregnancy that usually manifests as hypertension (blood pressure [BP] >140/90 mmHg) after 20 weeks with proteinuria that is due to:
Endothelial cell damage and vasospasm, which can affect the fetus and almost all maternal organs. It is of placental origin and cured only by delivery
Aspirin if at risk, labetalol to treat

387
Q

Eclampsia

A

Seizures as a result of preeclampsia
Magnesium sulphate can be used in severe disease, alongside labetalol
Steroids

388
Q

PCOS

A 
2+ from
-ovaries polycystic morphology on ultrasound
-irregular periods 5 or more weeks apart
-hirsuitism
Clomifene, metformin, uterine drilling
389
Q

Premenopausal symptoms

A

Symptoms of the perimenopause or menopause despite still having regular menstruation

390
Q

Pelvic inflammatory disease

A

Sexually transmitted pelvic infection
Multiparous, poor, sexually active risk factors
Analgesia and IM Ceftriaxone

391
Q

Prolactinoma

A

Pituitary tumour
Causes menstruation disturbance in women and erectile dysfunction in men
Hypogonadism, infertility and osteoporosis
Carbergoline agonist
Surgery

392
Q

Gestation DM

A

Altered carbohydrate metabolism, antagonistic effects of human placental hormone, progesterone and cortisol
Diet then metformin then insulin

393
Q

Sexuality

A

Sexual orientation refers to a person’s physical, romantic and/or emotional attraction towards other people.

394
Q

Lobe syndromes

A

Frontal- motor and personality
Parietal sound
Temporal smell
Occipital- vision

395
Q

Endocrine causes of altered mental state

A

Hypoglycaemia
Thyroid disturbance
Adrenal insufficiency
DKA

396
Q

Acute and transient psychosis

A

Less than 1 month

397
Q

Schizoaffective disorder

A

Mood change to

398
Q

Schiotypal disorder

A

Latent, family history, acting weird

399
Q

Persistent delusional disorder

A

Single or set of delusions held for more than 3 months

400
Q

Late paraphrenia

A

Late onset schizophrenia

401
Q

Induced delusional disorder

A

Same delusions in more than one person

402
Q

Mood stabilisers

A

Drugs used to prevent mania and depression in bipolar and schizoaffective disorders.
Valproate if not childbearing
Lithium if future adherence likely
(cabamazepine and lamotrigine also)

403
Q

Lithium

A

Long QT, hypothyroid, renal disturbance and tremor. Polyuria and polydipsia. Teratogenic
Before starting: ECG, TFT, U and E, eGFR, pregnancy test
Weekly monitoring until stable for 4 weeks and then 3 monthly
(if far too high then lots of fluid and NaCl)

404
Q

Valproate

A

Increased weight. Teratogenic, liver problems, polyphia

Before starting: BMI, pregnancy test, TFTs and PTT

405
Q

Which drug for mood stabilising a woman of childbearing age

A

Lamotrigine

Still gets headache, rash, tremor

406
Q

Endometrial polyps

A

40-50 when oestrogen levels are high
Menorrhagia and IMB
US
Resection with cutting diathermy

407
Q

Abnormal formation of uterus

A 
failure of fusion of mullerian ducts at 9 weeks. 
Unicornuate (half) uterus
Fundal septum
Vaginal septum
- hysteroscopic resection
408
Q

Prelabour rupture of membranes

A

After 37 weeks but before labour
Gush out of fluid. Avoid vaginal exam.
CTG and high vaginal swab
Antibiotics or immediate induction

409
Q

Premature labour

A

TVUS of cervical length
Nifedipine can be used as a tocolytic to prevent contractions
Magnesium sulphate for neuroprotection

410
Q

Constipation

A

Fluids, balanced diet, movicol then senna.

Hirschprungs, hypothyroid, coeliac or anus pathology

411
Q

Appendicitis

A

Central and colicky, goes to right illiac fossa. Worse on movement, guarding and tenderness.
Ultrasound
Appendectomy

412
Q

IBD

A

Crohns mouth to anus, enteral nutrition, beclamethasone then azathioprine
UC: blood diarrhoea, LLQ tenderness, toxic megacolon.
Beclamethasone and IV fluids then mesalazine

413
Q

Coeliac

A

Gliadin enteropathy.
Small intestine biopsy (villous atrophy, interepithelial lymphocytes, crypt hyperplasia)
Tissue translgutaminase, endomysial antibodies
Gluten free diet

414
Q

Intussuscpetion

A

Invagination of proximal bowel into distal segment. Redcurrent jelly stool. Sausage shaped mass.
Ultrasound
Tx rectal air insuffation or surgery

415
Q

Hirschprungs

A

Absence of myenteric plexus
Delayed passage of meconium
Suction rectal biopsy

416
Q

Nephritic syndrome

A

Post streptococcal
Oedema, hypertension, reduced urine output, haematuria, proteinuria
Fluid and electrolyte balance
Diuretics

417
Q

Polycystic kidney disease

A

Autosomal recessive- diffuse bilateral enlargement of both kidneys. Many small cysts
Autosomal dominant- seperate cysts of varying size between normal renal parenchyma

418
Q

Multicystic renal dysplasia

A

Kidney replaced by varying sized cysts. No normal renal parenchyma, ureter atresia

419
Q

Name 3 types of renal malformation

A

Polycystic kidney disease
Multicystic renal dysplasia
Potter syndrome

420
Q

Vesicoureteric reflux

A

Developmental anomaly of vesicoureteric junction
MAG3 or MCUG scan
more uti, pyelonephritis and renal damage
Treat with bulking injections or surgery

421
Q

Haemolytic uraemic syndrome

A

1) Acute renal failure
2) haemolytic anaemia
3) thombocytopenia
From EColi GI infection
Treat with dialysis

422
Q

Measles

A

Viral. Koplik spots (white spots on inside of cheeks), malaise, maculopapular rash
Encephalitis
Vitamin A can be given as worse complications in malnourished or immunocompromised

phase 3a (25 decks)

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